Healthcare Provider Details

I. General information

NPI: 1720485493
Provider Name (Legal Business Name): DEENA KOTLEWSKI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15204 OMEGA DR SUITE 100
ROCKVILLE MD
20850-4601
US

IV. Provider business mailing address

15204 OMEGA DR SUITE 100
ROCKVILLE MD
20850-4601
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-6750
  • Fax:
Mailing address:
  • Phone: 301-279-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0978
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: